How Can I Fix My Jaw Asymmetry and Prior Ear Reconstruction for Hemifacial Microsomia?
Q: Dr. Eppley, I’m interested in a custom facial implant to help correct my facial asymmetry due to hemi facial microsomnia. If I decide to proceed with that surgery, I’m also Interested in facial rejuvenation procedures if it’s possible to be performed in the same surgery. In regards to my microtia of the ear. I’ve had reconstructive surgery as a child. I’m curious with advancements in medicine, if anything was possible to better define my ear. I currently am not comfortable wearing my hair up without covering my ear.
A: Thank you for your inquiry and sending your pictures. I see as the major component of your facial asymmetry is that of the right chin/jawline. (see attached) Using a 3D CT scan a custom right jawline implant can be made to match the jawline length of the other side. The tilt in the smile line (mouth corners) will still persist however which can be improved by a left mouth corner lift. (easier to lift the lower normal side than lower the higher abnormal side)
For the ear there are two secondary problems with the ear reconstruction result. First, and a major one, is that the vertical length of the reconstructed ear is simply too long. I don’t know what the length of the other ear is but using the length of the nose as a guide, it can seen how long it is. (see attached) I think the cartilage framework was simply jnitiallly placed too high or made too big. How to change that is an interesting conundrum as it would involve a wedge resection of the middle part of the framework to vertically shorten it. The second more easily improved problem is that much of the ear lacks details without recognizable concavities between the helical rim and the antihelical fold/crus convexities. This could be improved by removing the skin on the outer surface of the ear and replacing it with a new skin graft after creating more detail in the cartilage framework.
Dr. Barry Eppley